HERITAGE WATERSIDE
NPI 1114501574
Assisted Living Facility in Daytona Beach Shores, FL
About Heritage Waterside NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
HERITAGE WATERSIDE (NPI 1114501574) is a healthcare organization registered as an assisted living facility in Daytona Beach Shores, Florida and active in the NPI registry since May 2021. The organization holds a CLIA Waiver certificate valid through February 27, 2027 and lists Mark Nagrani, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 10D2126489
Heritage Waterside · Daytona Beach, FLOther Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Heritage Waterside's NPI number?
The NPI number for Heritage Waterside is 1114501574. It was assigned to this organization in the NPPES registry on May 11, 2021.
Where is Heritage Waterside located?
Heritage Waterside is located at 3704 Cardinal Blvd, Daytona Beach Shores, FL 32118. The listed phone number is (386) 256-2015.
What is Heritage Waterside's specialty?
The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.
Does Heritage Waterside hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2126489) is associated with this NPI, valid through February 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Heritage Waterside was last updated on May 11, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Heritage Waterside · NPI 1114501574
Assisted Living Facility organization in Daytona Beach Shores, Florida. Organization record, active in the CMS NPPES registry since May 11, 2021.
## Identity
- **NPI:** 1114501574 (Entity type: Organization)
- **Enumerated:** May 11, 2021
- **Primary specialty:** Assisted Living Facility · taxonomy 310400000X
- **Organization subpart:** No
- **Authorized official:** Mark Nagrani, OWNER
## Practice location
- **Address:** 3704 CARDINAL BLVD, Daytona Beach Shores, FL 32118-7301
- **Phone:** (386) 256-2015
## Record status
- **NPPES last updated:** May 11, 2021
- **Other identifiers:** Medicaid 109599800 (FL)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1114501574) · Data from the CMS NPPES public registry.